Inguinal Hernia Symptoms in Men and Women: Warning Signs

The most common symptoms of an inguinal hernia are a bulge or swelling in the groin, the area where the lower abdomen meets the thigh next to the pubic bone, that becomes more obvious when you stand, cough or strain and often shrinks or disappears when you lie down, sometimes with heaviness, burning or a mild ache that increases with effort; in men the bulge may extend into the scrotum, while in women it is often smaller and harder to notice. Get emergency help immediately for any sudden or severe pain in the groin, the bulge, the scrotum, the lower abdomen or the pelvis; if the bulge becomes hard or tender to the touch, or no longer goes back in as it used to; if the skin over it turns red, purple or dark; or if the bulge or the pain comes with nausea, vomiting, fever, a swollen belly, or being unable to pass stool or wind. In women, any sudden or severe pain in the lower abdomen or pelvis needs emergency help immediately even when no bulge can be seen, especially during pregnancy or if pregnancy is possible.

Inguinal hernia symptoms in detail

Symptoms vary from person to person. Some people notice only a small, painless bulge, while others feel clear discomfort that affects work and movement. The most common symptoms are:

• A bulge in the groin: a soft swelling on one or both sides of the pubic area, more visible when standing, coughing, sneezing, carrying heavy things or straining on the toilet.
• A bulge that changes with position: it often shrinks or disappears when you lie on your back and comes back when you stand up.
• Heaviness or dragging in the groin: a pulling or pressure sensation that is usually worse at the end of the day or after standing for a long time.
• A mild ache or burning: around the bulge, increasing when you bend, lift or cough.
• Scrotal swelling in men: when part of the hernia slips down into the scrotum, making one side look larger than the other.

A hernia may cause no symptoms at first and then slowly grow over time. That is why any new bulge in the groin needs a medical examination, even if it is painless and disappears when you lie down.

When is an inguinal hernia an emergency?

The most serious complication is when part of the bowel or fatty tissue becomes trapped in the hernia opening and cannot go back in, known as an incarcerated hernia. Its blood supply can then be cut off, making it a strangulated hernia, which is an emergency that needs urgent surgery. Get emergency help immediately in any of these situations:

• Any sudden or severe pain in the groin, the bulge, the scrotum, the lower abdomen or the pelvis.
• The bulge becomes hard or tender to the touch, or no longer goes back in as it used to.
• The skin over the bulge turns red, purple or dark.
• The bulge or the pain comes with nausea, vomiting, fever, a swollen belly, or being unable to pass stool or wind.
• In women: any sudden or severe pain in the lower abdomen or pelvis, even when no bulge can be seen, especially during pregnancy or if pregnancy is possible.

Do not try to force a hard or painful bulge back in, and do not wait to see whether it settles on its own. The absence of these signs does not mean that every groin pain is safe: any new or worrying symptom needs a medical assessment.

What is an inguinal hernia?

An inguinal hernia is when part of the contents of the abdomen, usually fat or a loop of bowel, pushes through a weak point in the lower abdominal wall in the groin, specifically through the inguinal canal. This is a natural passage that carries the spermatic cord in men and the round ligament of the womb in women. Inguinal hernias are the most common type of abdominal wall hernia and are far more common in men than in women: studies suggest that about one in four men may develop one at some point in life, compared with a much smaller proportion of women.

There are two main types:

• Indirect inguinal hernia: passes through the inner opening of the inguinal canal, is often linked to a weakness present from birth, can appear at any age, and may extend into the scrotum in men.
• Direct inguinal hernia: bulges through a weak area in the back wall of the inguinal canal, is linked to muscle weakening with age, and is more common in middle-aged and older men.

An inguinal hernia is different from a femoral hernia, which appears just below the groin crease at the top of the thigh. Femoral hernias are less common overall, but they occur more often in women than in men and are more likely to become strangulated.

What does an inguinal hernia look like?

An inguinal hernia usually looks like a round or oval swelling under the skin in the groin, just above the crease where the abdomen meets the thigh and next to the pubic bone. It can range from a small bulge that only shows when you cough or stand to a large swelling that is visible even through clothing. Common features include:

• It feels soft, and the skin over it looks normal.
• It gets bigger when you stand, cough or strain, and often shrinks or disappears when you lie down.
• It can appear on one side or on both sides.
• In men it may extend into the scrotum, making one side look larger than the other.

Several other conditions can look similar, such as swollen lymph nodes in the groin, fluid around the testicle (a hydrocele), varicose veins of the scrotum (a varicocele) or a harmless fatty lump (a lipoma). They cannot be told apart by looking or feeling at home, so any swelling in the groin needs a medical examination.

Inguinal hernia symptoms in men

Men are more prone to inguinal hernias because of the way the inguinal canal develops: the spermatic cord passes through it to the testicle, leaving a potential weak point from birth. Common symptoms in men include:

• A bulge in the groin that appears when standing or with effort and often shrinks when lying down.
• Swelling on one side of the scrotum, or a heavy, dragging feeling that spreads to the testicle.
• Discomfort or a mild ache when lifting, bending or coughing, or after standing for long periods.

Sudden or severe pain in the scrotum or testicle can come from a strangulated hernia or from another emergency such as testicular torsion, and it needs emergency help immediately, as set out in the emergency signs above. Not every scrotal swelling is a hernia: a hydrocele or a varicocele can cause similar swelling, and a medical examination identifies the cause.

Inguinal hernia symptoms in women

Inguinal hernias are less common in women, but they can be harder to diagnose because the bulge is often smaller and may not be visible at all. Symptoms in women include:

• A small bulge in the groin or at the top of the outer lip of the vulva (labia majora), appearing when standing or coughing.
• Pain, pulling or burning in the groin that increases with effort or long periods of standing, even without an obvious bulge.
• A feeling of heaviness or pressure in the groin.

Because lower abdominal and pelvic pain in women has many causes, some of them emergencies such as an ectopic pregnancy, a twisted ovary (ovarian torsion) or appendicitis, this pain should never be put down to a hernia without an examination. In women, any sudden or severe pain in the lower abdomen or pelvis needs emergency help immediately even when no bulge can be seen, especially during pregnancy or if pregnancy is possible.

Femoral hernias are more common in women than in men and are more likely to become trapped and strangulated, so doctors usually lean towards repairing a groin hernia in a woman rather than simply monitoring it. Diagnosis may need an ultrasound or MRI scan when there are symptoms without a clear bulge.

Causes and risk factors

An inguinal hernia develops when a weakness in the abdominal wall meets repeated pressure inside the abdomen. The main causes and risk factors are:

• A weakness present from birth: part of the inguinal canal stays open after birth, the most common cause of an indirect hernia.
• Getting older: as muscles and connective tissue gradually weaken.
• Family history: a close relative who has had a hernia.
• A long-term cough: as in smokers and people with chronic lung disease.
• Chronic constipation and straining on the toilet, as well as difficulty passing urine linked to an enlarged prostate in men.
• Pregnancy: which raises the pressure inside the abdomen.
• Heavy lifting and long periods of standing: these may bring on symptoms in people who already have a weak point.
• A previous hernia: someone who has had a hernia on one side is more likely to develop one on the other side.

How is an inguinal hernia diagnosed?

In most cases the diagnosis is made by physical examination: the doctor examines the groin while you stand and asks you to cough or strain to bring out the bulge. When the diagnosis is unclear, as often happens in women or when there is pain without a bulge, the doctor may request an ultrasound scan, or an MRI or CT scan in some cases.

Does an inguinal hernia go away on its own?

An inguinal hernia does not go away on its own, in adults or in children, and exercises, belts or home remedies do not close the hernia opening. In babies and children, an inguinal hernia should be seen by a doctor promptly, because the risk of it becoming trapped is highest in infancy. Get emergency help immediately if a child with a groin or scrotal lump cries and cannot be settled, refuses feeds, vomits, or the lump becomes hard, tender, discoloured or no longer goes back in, or if the child has any of the emergency signs listed above. Surgical repair is the usual treatment, done either as open surgery or by keyhole (laparoscopic) surgery; in adults it is usually done with a medical mesh that reinforces the abdominal wall. The surgeon chooses the method according to the type and size of the hernia, the patient's general health, and whether the hernia is on one side or both.

For some men with a small hernia that causes few or no symptoms, the surgeon may suggest regular monitoring instead of immediate surgery, with a fresh assessment if symptoms increase. A hernia support belt (truss) does not treat the hernia and should only be used if a doctor advises it. Like any operation, hernia repair carries some risks, such as long-lasting groin pain or the hernia coming back in a proportion of patients.

What can help until you see a doctor?

The most important step is to see a doctor to confirm the diagnosis. Until then, these general measures may reduce discomfort:

• Treat chronic constipation with your doctor's help and eat fibre-rich foods to avoid straining on the toilet.
• Avoid heavy lifting where possible, and lift by bending your knees rather than your back.
• Have a long-term cough checked by your doctor, and stop smoking.
• Lie down and rest when the heavy feeling builds up at the end of the day.

Do not try to force the bulge back in. If any of the emergency signs above appears at any time, get emergency help immediately.

Frequently Asked Questions

Is an inguinal hernia dangerous?

Most inguinal hernias are not an emergency when they are first found, but they do not go away on their own, and the fat or bowel inside can become trapped and lose its blood supply, a serious complication that needs urgent surgery. Get emergency help immediately for any sudden or severe pain in the groin, the bulge, the scrotum, the lower abdomen or the pelvis; if the bulge becomes hard or tender to the touch, or no longer goes back in as it used to; if the skin over it turns red, purple or dark; or if the bulge or the pain comes with nausea, vomiting, fever, a swollen belly, or being unable to pass stool or wind. In women, any sudden or severe pain in the lower abdomen or pelvis needs emergency help immediately even when no bulge can be seen, especially during pregnancy or if pregnancy is possible. Even when symptoms are mild, any bulge in the groin needs a medical examination to confirm the diagnosis and plan the right care.

What is an inguinal hernia, and how does it happen?

An inguinal hernia is when part of the contents of the abdomen, usually fat or a loop of bowel, pushes through a weak point in the abdominal wall in the groin, showing up as a bulge in the groin next to the pubic bone. It happens because of a weakness in the inguinal canal present from birth or one that develops with age, and anything that raises the pressure inside the abdomen, such as a chronic cough, constipation, straining or pregnancy, makes it more likely. Get emergency help immediately for any sudden or severe pain in the groin, the bulge, the scrotum, the lower abdomen or the pelvis; if the bulge becomes hard or tender to the touch, or no longer goes back in as it used to; if the skin over it turns red, purple or dark; or if the bulge or the pain comes with nausea, vomiting, fever, a swollen belly, or being unable to pass stool or wind. In women, any sudden or severe pain in the lower abdomen or pelvis needs emergency help immediately even when no bulge can be seen, especially during pregnancy or if pregnancy is possible.

What does an inguinal hernia look like?

An inguinal hernia usually looks like a soft, round or oval swelling under the skin in the groin, just above the crease and next to the pubic bone. It gets bigger when you stand, cough or strain, often shrinks or disappears when you lie down, and the skin over it looks normal. In men it may extend into the scrotum, while in women it is often smaller and harder to notice. Other conditions, such as swollen lymph nodes, can look similar, and only a medical examination can tell them apart. Get emergency help immediately for any sudden or severe pain in the groin, the bulge, the scrotum, the lower abdomen or the pelvis; if the bulge becomes hard or tender to the touch, or no longer goes back in as it used to; if the skin over it turns red, purple or dark; or if the bulge or the pain comes with nausea, vomiting, fever, a swollen belly, or being unable to pass stool or wind. In women, any sudden or severe pain in the lower abdomen or pelvis needs emergency help immediately even when no bulge can be seen, especially during pregnancy or if pregnancy is possible.

What are the symptoms of an inguinal hernia in men?

The most common symptoms in men are a bulge in the groin that appears when standing or with effort and often shrinks when lying down, swelling on one side of the scrotum, a heavy or dragging feeling that spreads to the testicle, and discomfort or a mild ache when lifting, bending or coughing. Sudden or severe pain in the scrotum can come from a strangulated hernia or from testicular torsion. Get emergency help immediately for any sudden or severe pain in the groin, the bulge, the scrotum, the lower abdomen or the pelvis; if the bulge becomes hard or tender to the touch, or no longer goes back in as it used to; if the skin over it turns red, purple or dark; or if the bulge or the pain comes with nausea, vomiting, fever, a swollen belly, or being unable to pass stool or wind. In women, any sudden or severe pain in the lower abdomen or pelvis needs emergency help immediately even when no bulge can be seen, especially during pregnancy or if pregnancy is possible.

What are the symptoms of an inguinal hernia in women?

Symptoms in women are often less obvious than in men: the bulge is usually smaller and may appear in the groin or at the top of the outer lip of the vulva, or there may only be pain, pulling or heaviness in the groin that increases with effort or long periods of standing. Because lower abdominal and pelvic pain in women has other causes that can be emergencies, such as an ectopic pregnancy or a twisted ovary, it should not be put down to a hernia without an examination, and diagnosis may need an ultrasound or MRI scan. Get emergency help immediately for any sudden or severe pain in the groin, the bulge, the scrotum, the lower abdomen or the pelvis; if the bulge becomes hard or tender to the touch, or no longer goes back in as it used to; if the skin over it turns red, purple or dark; or if the bulge or the pain comes with nausea, vomiting, fever, a swollen belly, or being unable to pass stool or wind. In women, any sudden or severe pain in the lower abdomen or pelvis needs emergency help immediately even when no bulge can be seen, especially during pregnancy or if pregnancy is possible.